Ducharme-Smith Allison, Katz Ben Z, Bobrowski Amy E, Backer Carl L, Rychlik Karen, Pahl Elfriede
Northwestern Feinberg School of Medicine.
Departments of b?>Pediatrics.
J Heart Lung Transplant. 2015 Feb;34(2):222-6. doi: 10.1016/j.healun.2014.09.043. Epub 2014 Oct 24.
BK polyomavirus (BKV) infection and nephropathy complicate renal allografts; however, their effect in the native kidneys of pediatric heart transplant (HTx) recipients is unknown. We assessed the prevalence of BKV infection and its association with kidney dysfunction in survivors of pediatric HTx.
A single-center retrospective study compared pediatric (aged <18 years ) HTx recipients, with and without BKV (controls), who received an allograft from May 1989 to July 2013. Screening of urine for BKV was performed in patients with chronic kidney disease (CKD) stage ≥2 since 2006, and since April 2012 in all HTx recipients at least at an annual evaluation. Serum for BKV DNA was assayed if BK viruria was present. Data collected included recipient and donor demographics, the immunosuppressive regimen, and history of Epstein-Bar virus (EBV) and cytomegalovirus infection. Statistics included Fisher's exact test, chi-square test, Student's t-test, and multivariate logistic regression.
Of 98 eligible recipients, 83 (85%) were screened: 28 (34%) had BK viruria, and 7 had BK viremia. One viremic patient had biopsy-proven BKV nephropathy that progressed to end-stage renal disease. Risk factors for BK viruria were (1) longer duration since HTx (6.02 vs 2.95 years; p = 0.01), (2) worsening estimated glomerular filtration rate (71.3 vs 86.3 ml/min/1.73 m(2), p = 0.03), (3) history of EBV infection (p = 0.0002), and (4) use of sirolimus (p = 0.0003). After multivariate logistic-regression, only history of EBV infection remained associated with BKV infection (p = 0.015).
BKV may lead to BK viremia and BK nephropathy in pediatric HTx patients. Routine screening for BK viruria should be considered.
BK多瘤病毒（BKV）感染及肾病会使肾移植复杂化；然而，其在小儿心脏移植（HTx）受者的天然肾脏中的作用尚不清楚。我们评估了小儿HTx存活者中BKV感染的患病率及其与肾功能障碍的关联。
一项单中心回顾性研究比较了1989年5月至2013年7月接受同种异体移植的小儿（年龄<18岁）HTx受者，分为有BKV感染组（病例组）和无BKV感染组（对照组）。自2006年起，对慢性肾脏病（CKD）≥2期的患者进行尿液BKV筛查，自2012年4月起，对所有HTx受者至少每年进行一次评估时进行尿液BKV筛查。若存在BK病毒尿，则检测血清BKV DNA。收集的数据包括受者和供者的人口统计学资料、免疫抑制方案以及EB病毒（EBV）和巨细胞病毒感染史。统计学分析包括Fisher精确检验、卡方检验、Student t检验和多因素logistic回归分析。
98名符合条件的受者中，83名（85%）接受了筛查：28名（34%）有BK病毒尿，7名有BK病毒血症。1名病毒血症患者经活检证实患有BKV肾病，并进展为终末期肾病。BK病毒尿的危险因素为：（1）HTx后时间更长（6.02年对2.95年；p = 0.01），（2）估计肾小球滤过率恶化（71.3对86.3 ml/min/1.73 m²，p = 0.03），（3）EBV感染史（p = 0.0002），（4）使用西罗莫司（p = 0.0003）。多因素logistic回归分析后，仅EBV感染史仍与BKV感染相关（p = 0.015）。
BKV可能导致小儿HTx患者发生BK病毒血症和BKV肾病。应考虑对BK病毒尿进行常规筛查。
